Tag: recovery from psychosis
A skilled approach to working with beliefs involves both toleration of differences in perspective and an awareness of a variety of possible things that can be tried when a belief is causing problems that do not seem to be tolerable, either to the person or to others with whom they must interact.
What would mental health treatment look like if it balanced an awareness of the need for “recovery” with an awareness that people also sometimes need to go “out of their minds” to resolve problems that they haven’t been able to solve otherwise, or maybe that their entire culture has not been able to face and resolve?
When John Herold went to see a Process Work counselor, they talked about how his experience of extreme states had been disruptive in his life, but how these states also had value. The counselor compared John's experience with drinking an entire bottle of Tabasco sauce all at once. Why not instead, the counselor suggested, "try being just a little psychotic all the time?"
If a person recognizes the “alien” parts of themselves as being parts of themselves, they are likely to be seen as having PTSD or a dissociative disorder. If they see the “alien” parts of themselves as being literally aliens, or demons, they will likely be diagnosed as psychotic. But these experiences are really on a spectrum.
It makes sense to be cautious about any kind of exploratory practice that might send someone who has been "psychotic" into another period of being lost and confused. But we should also beware the risk of trying to be too stable and "normal" after psychosis — the risk of avoiding the transformative work that might need to happen for that person.
You can’t go back to mundane ways of seeing the world after very dark things happen. Trauma cracks open a hole in our lives and in our minds, throwing us into the zone where we face the big spiritual questions. Bad ideas can get in when things open up like that. But it’s also possible that something new and positive can get in.
Just “recovering” one’s previous way of functioning is not so likely to work, because usually something wasn’t working prior to the psychosis. It was that which set off the psychosis, and if that isn’t changed, any “recovery” may not be worth much, as the problems, and so the need to transform, will likely still be present.
We seldom have a chance to hear from someone who combines the perspective of a longtime psychiatric survivor and activist with that of being a psychiatrist. I disagreed with only one significant point — that a person does not have to be off all medications to show “complete recovery” from “mental illness.”
Is madness good for something? If there is something positive about psychosis, then perhaps what we really need is a balanced view, somewhere between “romanticizing” it as being all good and “awfulizing” it as being all bad.
In my graduate education, we were taught how to deal with a wide variety of human troubles — but one big exception was psychosis! For that, we were told to send our clients to the psychiatrist.
I was recently asked to contrast my views on psychosis and recovery with those offered by NAVIGATE, a US government (NIMH) sponsored program aiming to guide early intervention programs for psychosis. This inspired me to inquire into what NAVIGATE does tell people and families about psychosis and recovery. What I found, unfortunately, was quite disturbing.
As Burning Man nears its 30th anniversary, USA Today has published an article attempting to explain how this still somewhat freakish event came into existence. I enjoyed the article, but as someone involved in the origin story it tells, I believe that an important piece is being left out. This relates to how misguided “mental health treatment” came close to disabling a key organizer of the early Burning Man. This piece is a fascinating tale in itself, but more fascinating when considered as just one example of how a flawed approach to mental health treatment forms a barrier to many forms of cultural evolution and renewal, with oppressive consequences for society as a whole.
In the past five years, there has been a dramatic explosion of interest in the Open Dialogue Therapy practiced in Tornio, Finland. It is a humanistic “treatment” that has produced five-year outcomes for psychotic patients that are, by far, the best in the developed world, and there are now groups in the United States, Europe and beyond that are seeking to “import” this care. However, the challenges for doing so are many and, last month, Open Dialogue UK - on the occasion of the first-ever fully recognized Open Dialogue training outside of Tornio - organized a conference in London to hold an open dialogue about Open Dialogue.
When people are “mad,” they are often insisting that certain things are so, and frequently seem unwilling or incapable of appreciating or learning from other perspectives. Yet when the supposedly “sane” mental health system approaches those who are mad, it typically does the same thing – it insists that its own view of what’s going on is correct, and seems incapable of appreciating or learning from others, whether they be the patient, the family, former users of services, or anyone who understands madness in a different way.
The 90s were labeled - rather optimistically - as the ‘decade of recovery.’ More recently, recovery has been placed slap bang central in mental health policy. Is supporting recovery pretty much good common sense? Or is the term being misused to pressure those suffering to behave in certain ways?
I was a psychiatrist who participated in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE ETP). Although I welcomed the positive headlines that heralded the study's results, the reports left me with mixed feelings. What happened to render the notion that talking to people about their experiences and helping them find jobs or go back to school is something novel?
That was the emphatic response from my grad school psychopathology professor 35 years ago, after I'd stated in her class that anyone could become psychotic given sufficient life stressors, losses and trauma. How many current mental health professionals, especially psychiatrists, also believe they have such strong egos that they never could experience extreme states?
It has been five years since I traveled to Western Lapland in Finland to film my documentary “Open Dialogue” on their Open Dialogue Project—the program, as I stated in the film, presently getting the best long-term statistical results in the world for the treatment of first-episode psychosis. My film came out four years ago, and since then I have been screening it around the world, giving lectures about Open Dialogue and my experience in Finland, participating in regular conferences and Q&A sessions about it, receiving daily emails, Facebook messages, blog and Youtube comments about it (as it’s now been free on Youtube for a year), and keeping in regular contact with some of the folks who work there. But I haven’t shared many of my updated opinions in writing, so I wish to do so now.